Migrénes és tenziós fejfájásban szenvedő betegek életminőségének vizsgálata az impulzivitással, empátiás készséggel, depresszív szindrómával és vitális kimerültséggel való összefüggésben = Examination of the quality of life of migraineurs and tension headache patients in connection with impulsivity, empathy, depression, and vital exhaustion

A fájdalomszindrómák depresszióval való kapcsolata részletesen dokumentált a szakirodalomban. Az impulzivitás és az empátiás készség kevésbé vizsgált vonás. Korábbi megfigyeléseink szerint az impulzivitás a migrénes betegek többségére jellemző, empátiás készséget pedig inkább a nőbetegek mutatnak. A Nemzetközi Fejfájás Társaság (International Headache Society) kritériumai szerint diagnosztizált 87 beteggel (40 migrénes és 47 tenziós fejfájós, átlagéletkoruk 34 év) vettük fel a Beck Depresszió Kérdőívet (BDI), a Vitális Kimerültség Kérdőívet, az Eysenck-féle Impulzivitás–Kockázatvállalás–Empátia (IVE) Kérdőívet, valamint a Wagner-féle Migrénspecifikus Életminőség-kérdőívnek az első szerző által kifejlesztett és korábbi vizsgálatban faktorokra bontott magyar változatát. Eredményeink egyrészt igazolják az Életminőség-kérdőív magyar változatának diszkriminatív validitását és megbízhatóságát. A teljes vizsgált mintában a BDI-pontszámmal negatívan korrelál az Életminőség-kérdőív összpontszáma (r = –0,436; p<0,001) és az általunk kimutatott négy faktora közül három, a Vitális Kimerültség Kérdőívének pontszámával pedig az összpontszám (r = –0,50; p<0,001) és mind a négy faktor negatívan korrelál. Migrénesek esetében az összpontszám és mind a négy kimutatott faktor diszkriminatív validitására, tenziós fejfájósok esetében az összpontszám, valamint az affektív és szociális faktor diszkriminatív validitására utaló eredményeket kaptunk. A kérdőív jó belső konzisztenciája (0,772 és 0,910 közötti Cronbach-alfa értékek) a megbízhatóságra szolgáltat adatot. Eredményeink másrészt feltevéseinkkel összhangban az impulzivitás és empátia fordítottan arányos együttjárását (r = –0,368; p<0,001), valamint az Életminőség-kérdőív szociális faktorának az empátiával való negatív korrelációját (r = –0,237; p<0,05) mutatják. A migrénesek tenziós fejfájósokhoz viszonyítva impulzívabbak (átlag: 8,65 vs. 6,09; p<0,01) – ez az adat a korra és betegségtartamra való kontrollálás után is szignifikáns maradt. A nőbetegek férfiakhoz viszonyítva erősebb empátiával rendelkeznek (átlag: 17,89 vs. 10,82; p<0,001) – várakozásainknak megfelelően. Mindezek alapján a relaxációs és kognitív pszichoterápiás módszerek hasznosságára következtetünk a primer fejfájós betegek állapotának javítása szempontjából. | The connection between chronic pain and depression is abundantly documented in the literature. Impulsivity and empathy are less studied in primary headache patients. In our psychotherapeutic experience most of our migraine patients have shown signs of impulsivity, and female patients particularly have displayed empathic concern. We examined 87 patients (40 migraineurs and 47 tension headache patients following the criteria set by the International Headache Society, mean age 34 years) using the Beck Depression Inventory, the Vital Exhaustion Questionnaire, Eysenck’s Impulsivity–Venturesomeness–Empathy Questionnaire, and Wagner’s MSQ. The latter examines the quality of life of migraineurs; its Hungarian version was developed by the first author of the present study. Our results confirm the discriminative validity and reliability of the Hungarian version of the quality of life questionnaire. Depression score for the whole sample shows a negative correlation with the total quality of life score (coeff: –0.436; p<0.001) and with three of its four factors. The vital exhaustion score also correlates negatively with the total quality of life questionnaire score (coeff: –0.500; p<0.001) and all four of its factors. For migraineurs, our data confirm the discriminative validity of the total score and of all four factors of the quality of life questionnaire. For tension headache patients, evidence is found for the discriminative validity of the total score as well as the affective and social factors of the questionnaire. The high Cronbach’s alpha values – between 0.772 and 0.910 – prove the reliability of the questionnaire. The results also confirm our hypotheses of an inverse correlation between impulsivity and empathy (coeff: –0.368; p<0.001) and an inverse correlation of empathy with the social factor in the quality of life questionnaire (coeff: –0.237; p<0.05). Migraineurs were found to have a higher level of impulsivity than tension headache patients (means: 8.65 vs. 6.09; p<0.01) – this evidence remained significant after controlling the results for age and length of disease history. Female patients were found to have stronger empathy than male patients (mean: 17.89 vs. 10.82; p<0.001), as expected. The usefulness of relaxation techniques and cognitive psychotherapeutic methods in improving primary headache patients’ status is discussed

Clinical Supervision in the Mirror of Cutting-Edge Research

Milne, D. (2009) Evidence-Based Clinical Supervision: Principles and Practice (Oxford: Wiley-Blackwell) 272 pp., 23 cm, ISBN 978-1-4051-5849-

Altered neural activity to monetary reward/loss processing in episodic migraine

The dysfunctions of the mesolimbic cortical reward circuit have been proposed to contribute to migraine pain. Although supporting empirical evidence was mainly found in connection with primary rewards or in chronic migraine where the pain experience is (almost) constant. Our goal however was to investigate the neural correlates of secondary reward/loss anticipation and consumption using the monetary incentive delay task in 29 episodic migraine patients and 41 headache-free controls. Migraine patients showed decreased activation in one cluster covering the right inferior frontal gyrus during reward consumption compared to controls. We also found significant negative correlation between the time of the last migraine attack before the scan and activation of the parahippocampal gyrus and the right hippocampus yielded to loss anticipation. During reward/loss consumption, a relative increase in the activity of the visual areas was observed the more time passed between the last attack and the scan session. Our results suggest intact reward/loss anticipation but altered reward consumption in migraine, indicating a decreased reactivity to monetary rewards. The findings also raise the possibility that neural responses to loss anticipation and reward/loss consumption could be altered by the proximity of the last migraine attack not just during pre-ictal periods, but interictally as well

Personality traits and psychological complaints under patients suffering from headaches

Background and purpose – Although headaches are often comorbid with psychological symptoms, the underlying psychological processes, e.g. the role of personality dimensions as headache determinants remains unclear. Studies found associations between headaches and various personality traits; according to the Big Five model of personality, persons suffering from headaches exhibit a higher rate in neuroticism, while a lower rate in extraversion, openness to experiences and positive emotions. This is the first study to clarify the associations among duration, intensity, and frequency of headaches and personality dimensions. Through this study we could get into the personality dimensions in the background of pain experience and that which personality dimensions bear a part in the behaviour of the persons, who suffered from headache, but do not seek treatment through this complaint. Methods – Treated (Group1) and untreated (Group2) headache patients and healthy controls (Group3) were investigated (total of 360 participants). The main headache components of intensity, duration, and frequency were used as dependent variables with personality dimensions in the Big Five concept investigated by the NEO-PI-R Personality Inventory. Results – Employing multiple regression analysis, facets of personality described 14.7% of headache intensity, 10.9 % of duration, and 18.7 % of frequency variance. Group1 and Group2 reached significantly higher values on the dimension of anxiety, depression, and vulnerability to stress than Group3. Group1 showed a significantly higher value on trust personality dimension than Group3 and Group2. Group3 exhibited a significantly higher value in the trust dimension than Group2. Concerning vulnerability to stress, the highest value was yielded by the “treated and suffering from headaches” group and there was a significant difference also with the “untreated and suffering from headaches” group and with the control group. In this dimension, the “untreated and suffering from headaches” group’s point value was significantly higher than the control group’s (p<0.01, U=-4.501). Conclusion – Our study demonstrates that the three headache components are not independent from personality traits, and personality traits may interact with treatment seeking behavior even in the presence of significant headache complaints. The role of the personality traits are significant in the intensity, duration and frequency of headaches

Callous-unemotional traits and neural responses to emotional faces in a community sample of young adults

Former studies suggest that the core features of psychopathy, namely the callous-unemotional (CU) traits are associated with emotional dysfunction characterized by atypical processing of other people's distress. Using a dimensional approach to CU traits, the current study aims to test neural activity during performance of a facial expression recognition task in a community sample of young adults. Forty-one participants (25 females, M age = 25.44, SD = 4.03) completed the Inventory of Callous-Unemotional Traits. Functional magnetic resonance imaging data were collected to measure neural responses to fearful, happy and sad faces as compared with neutral facial expressions. Region-of-interest analyses revealed that during exposure to fearful face expressions, blood oxygenation level-dependent responses were negatively associated with CU traits in the right anterior cingulate gyrus (ACCg), but not in the amygdala. These findings support that CU traits are related to a unique neural response to fearful faces in noncriminal population as well. It also highlights the importance of taking into account other regions outside the amygdala, in particular the ACC, when testing the relation between CU traits and fear response. © 2017 The Author